Individual provider Active NPI

Travis Pickens, OD

  • Optometrist
  • Southport, NC
National Provider Identifier
1053346783
Registry record updated Oct 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2098 Issued in NC
Practice address
5211 Eason St
Southport, NC 28461-6901
Phone
(910) 454-0563
Fax
(910) 454-0567
NPI assigned
Jul 11, 2006
Last updated
Oct 27, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2098 NC Primary

Addresses

Primary practice location

5211 Eason St
Southport, NC 28461-6901

Mailing address

1729 New Hanover Medical Park Dr
Wilmington, NC 28403-5345
Phone (910) 763-3601

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080505000495 NC Practitioner - Optometry 0446293658 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wilmington Eye, P.a.Group PAC ID 8921034323, 29 clinicians

Practice addresses (Care Compare)

1729 New Hanover Medical Park Dr
Wilmington, NC 28403-5345
Phone (910) 763-3601

Merit-based Incentive Payment System (MIPS)

Final score
89.61 of 100Reported as group
Quality
91.39
Promoting interoperability
100
Improvement activities
40
Cost
73.98

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3098NCMDProfessional Counselor
2098NCMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Wilmington Eye, P.a. CurrentSince Apr 1, 2008 Accepting new patients
Wilmington Eye, P.a. CurrentSince Apr 1, 2008 Accepting new patients

Locations

5211 Eason St
Southport, NC 28461
Phone (910) 454-0563

5211 Eason St
#1
Southport, NC 28461
Phone (910) 454-0563

1729 Medical Park
#P
Wilmington, NC 28403

1729 New Hanover Medical Park Dr
Wilmington, NC 28403
Phone (910) 772-8261

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: tpickens@wileye.intellechartdirect.net

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603756800000",
    "number": "1053346783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1729 NEW HANOVER MEDICAL PARK DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284035345",
            "telephone_number": "910-763-3601",
            "fax_number": "910-763-4608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5211 EASON ST",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "284616901",
            "telephone_number": "910-454-0563",
            "fax_number": "910-454-0567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PICKENS",
        "first_name": "TRAVIS",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2020-10-27",
        "certification_date": "2020-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NC",
            "license": "2098",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southport, NC

Sources for this page

Verify at the official NPI Registry.